Adult-onset bilateral optic neuritis: a rare presentation

A rare case of adult-onset bilateral optic neuritis without associated autoimmune or infectious disorders has been reported in this study. A 19-year-old male described sudden bilateral diminution of vision (sequential) with headache with no other remarkable history. Ophthalmological findings revealed asymmetrically reduced visual acuity on the initial visit. Fundus examination showed nerve fibre layer oedema (more in right eye). Radiological examination was suggestive of bilateral, asymmetrical optic neuritis. Visual evoked potential tests suggested asymmetrical and sequential P100 delay. No auto-immune/infectious aetiology was found. The condition was diagnosed as an atypical presentation of optic neuritis with sequential bilateral involvement. Patient was treated with intravenous methyl prednisolone followed by tapering oral doses owing to the bilaterality of the involvement. A careful follow-up is being performed. The condition involving bilateral inflammation of the optic nerves can have hazardous outcome and hence prompt, careful and comprehensive diagnostic and treatment approach is necessitated.

Cardiac hemodynamic profile and its correlates by Impedance plethysmography in normal individuals of Central India.

Evaluation of hemodynamic profile by impedance plethysmography (IPG) provides functional expression of cardiovascular performance with efficacy of treatment. Objective of this study was to establish normative hemodynamic parameters by IPG. In this cross-sectional study hemodynamic parameters including cardiac output (CO), Stroke volume (SV), left ventricular ejection time (LVET), impedance (Zo) Cardiac index (CI) and Stroke index (SI) of 50 normal individuals in mean age 38.9±15.2 years were evaluated. Mean CO and CI were 4.9±0.8L/min and 3.3±0.7 L/min/m2 respectively. A negative linear co-relation of CI with increasing age and body fat mass was observed. Mean LVET was 336±33ms with a significant positive linear correlation (r = 0.46) with advancing age and body fat mass while a negative linear correlation with BSA. To conclude preliminary normative data of cardiac parameters using IPG, in subjects of central India of different age groups has been presented.

Usefulness of blink reflex in hypothyroid patients with or without polyneuropathy :a case control study.

Central nervous system (CNS) dysfunction is an important consequence of thyroid deficiency. Cranial nerves are frequently affected in hypothyroid process. On routine nerve conduction studies, symptomatic peripheral and cranial neuropathy can be detected, however, diagnosing subclinical cranial neuropathy pose the major problem. Blink reflex (BR), has been shown to be an effective method for revealing subclinical involvement of cranial nerves in generalized neuropathies. The present study was undertaken to evaluate the efficacy of BR as a method for early diagnosis of subclinical cranial neuropathy in hypothyroid patients with or without overt peripheral polyneuropathy. A case control study was conducted on 150 subjects aged 18 years and above (100 controls, 50 cases). A routine nerve conduction study and BR evaluation was done in all the subjects. We found abnormal BR response in 50% of hypothyroid patients studied. In hypothyroid patient without polyneuropathy R1 latency was significantly prolonged (P<0.05 Vs control).Ipsilateral and contralateral R2 latencies were significantly prolonged in hypothyroid cases with or without polyneuropathy on bilateral stimulation. Magnitude of prolongation was greater in with polyneuropathy group. In conclusion, study suggests that BR is a useful non-invasive method for the detection of clinically silent cranial nerve compromise in hypothyroid patients.

Assessment of nerve conduction study to establish most common electrophysiological predictor of lumbosacral radiculopathy among radiologically diagnosed L5S1 neural foramina compression cases.

Magnetic resonance imaging (MRI) and electromyography (EMG) are complimentary investigations in diagnosis of lumbosacral radiculopathy (LSR). With changing pattern of S1 electrodiagnosis by H-reflex study measures, electrophysiological studies were conducted to establish most common electrophysiological predictors of LSR in MRI diagnosed L5S1 neural foramina compression subjects. Fifty subjects, with definite L5S1 neural foramina compression underwent electrophysiological evaluation and the data was analyzed using established electrodiagnostic criteria. Reduced H/ M ratio in combination with absent H response was evident in 74 nerves. H-reflex study was abnormal in 88% subjects. Study concluded that, H/M ratio if used with other H-reflex study variables may be most common predictor of LSR.

Association of pattern reversal VEP parameters with the Meandefect of Humphrey visual field in patients of primary open Angleglaucoma.

Glaucoma is a chronic, progressive bilateral optic neuropathy which disturbs the structural or functional integrity of the optic nerve that causes characteristic atrophic changes in it, which leads to specific visual field defects over time with loss of visual function. Primary open angle glaucoma (POAG) is the most common form of glaucoma in India and is fast emerging as a major cause of bilateral blindness. This rural hospital based study was conducted to evaluate whether glaucomatous visual field defects particularly the mean defect of Humphrey visual field could be related to VEP parameters of patients having POAG. Visual field by Humphrey perimeter and simultaneous recordings of pattern reversal visual evoked potential (PRVEP) were assessed in 100 patients with POAG. There was a significant (P<0.05) negative correlation of P100 latency, N155 latency and P100 duration and a highly significant (P<0.001) positive correlation of P100 amplitude with mean deviation (index of global visual field damage, MD) of Humphrey visual field in the subjects of POAG in various age groups. N70 latency showed a non-significant positive correlation with MD. The VEP changes observed by us in POAG patients were consistent with the progressing mean defect quantitatively. Therefore, it can be concluded that the VEP parameters can be useful quantitative indices in the evaluation of glaucomatous visual function damage.

Association of Obesity and Leptin with Insulin Resistance in Type 2 Diabetes Mellitus in Indian Population.

Obesity and diabetes mellitus are two modern epidemics. But their interrelationship is debated. Here we explored the probable association among obesity, leptin and insulin resistance in type 2 diabetes mellitus. 60 recent onset (<5 years) diabetics and age-sex matched 33 non diabetic controls were assessed for physical and chemical parameters like Body Mass Index, abdominal circumference, waist/hip ratio, fasting blood glucose, insulin and leptin. Degree of insulin resistance was calculated by HOMAIR method (Homeostatic Model Assessment). All the physical parameters showed positive correlation with leptin and the HOMA-IR score, strength of association being highest between insulin resistance and abdominal circumference. Leptin and insulin resistance showed no correlation. Findings were lower in controls. Study concluded that, obesity mainly central type might be responsible for insulin resistance in type 2 diabetes mellitus where as leptin, a potential marker for obesity, may not. This perhaps points towards the multifactorial causation of insulin resistance in type 2 diabetes mellitus.

Students’ perception on seminars: a questionnaire study.

Introduction: Considering the rising intellect of students and the developing scientific temper among undergraduates the concept of seminars was introduced to first year MBBS students. The innovative approach (concept of seminar) for the learning of first year medical subjects needs to be evaluated periodically. A questionnaire was designed to obtain feedback from students. Methods: First year medical students were given a questionnaire comprising of eleven questions. Results: The views obtained by students were calculated as percentage and discussed. Conclusion: The majority of students has considered it to be good method of self-learning and were in support of continuation of such a system in forthcoming years.

Effect of gender on antisperm antibodies in infertile couples in central India.

The presence of antisperm antibodies in serum may impair sperm function leading to immunological infertility. The aim of study was to determine the presence of antisperm antibodies in the circulating blood of infertile couples. This cross sectional study included 109 couples suffering from infertility for more than one-year duration. Serum antisperm antibodies were determined by Varelisa Sperm Antibodies Enzyme Immunoassay kit. The percentage incidence of antisperm antibodies in infertile men was 30.27% was statistically not significant from the 33.03% incidence in infertile women (P Value >0.05). In the nineteen (15.59%) couples both the husband as well as wife was positive for sperm antibodies. The presence of antisperm antibodies may impair fertilizing ability therefore its assessment should be considered as an essential part of infertility management.

Effect of body mass index on parameters of nerve conduction study in Indian population.

As the adipose tissue in epineurium is related to some extent to amount of body fat, it is possible that the amount of such fat may affect the nerve conduction. In this study, we have analyzed effect of Body Mass Index (BMI) on various parameters of nerve conduction study in one hundred seventy five healthy volunteers between ages of 18 and 66 years. BMI was determined and nerve conduction studies were performed prospectively in all the subjects using standardized techniques. Prolongation of distal motor latency (DML) was observed with increasing BMI except in motor Peroneal nerve. (In Median Nerve, P<0.05). F- Wave minimum latency was also found to be significantly prolonged in (P<0.05) in motor Tibial nerve. Higher BMI was found to be non-significantly associated with lower amplitude (both sensory and motor) except for peroneal nerve. Motor as well as sensory conduction velocity showed non-significant slowing along increasing BMI except sural and motor-sensory ulnar nerve in younger age group. This study demonstrated that various parameters of nerve conduction study can be affected by BMI. So, this biological factor has to be taken into consideration while interpreting nerve conduction studies

Normative data of upper limb nerve conduction in central India.

Nerve conduction study is an important tool to evaluate peripheral nerve abnormality. The primary purpose of this study was to provide normative electrophysiological data for commonly tested upper limb nerves in normal healthy adults. Nerve conduction studies were performed prospectively in upper limbs of 175 carefully screened healthy volunteers between the ages of 18 and 66 years using standardized techniques. There was no statistically significant difference found in conduction velocity and amplitude of motor median and ulnar nerves as well as sensory conduction velocity of median nerve. However, distal and F-minimum latencies of motor nerves, sensory amplitudes and conduction velocity of ulnar nerve was found to be significantly influenced by gender (P<0.05). This study established normative conduction parameters of the commonly tested nerves of upper limb for our clinical neurophysiology laboratory in Central India. This can be of use to evaluate the patients with peripheral nerve abnormalities who reside in this particular geographic set-up. Gender was shown to have an influence on sensory amplitude, distal motor and Fminimum latencies of median and ulnar nerves.

Auditory evaluation of the microcephalic children with brain stem evoked response audiometry (BERA).

Microcephaly implies a reduced occipito-frontal circumference (< 2 Standard Deviation of normal) and therefore a small brain size, which is usually associated with different neurodeficit. Intactness of the auditory pathway in microcephalic as well as normal children was assessed by Brain stem Evoked Response Audiometry (BERA) to locate the exact site of lesion resulting in the auditory impairment, so that appropriate early rehabilitative measures can be taken. The study revealed that absolute peak latency of wave V, inter peak latencies of III–V and I–V were significantly higher (P- value <0.05 in each case) in microcephalics than the normal children. Auditory impairment in microcephaly is a common neurodeficit that can be authentically assessed by BERA. The hearing impairment in microcephalics is mostly due to insufficiency of central components of auditory pathway at the level of brainstem, function of peripheral structures being almost within normal limit.

Assessment of nerve conduction in evaluation of radiculopathy among chronic low back pain patients without clinical neurodeficit.

The diagnostic evaluation of chronic low back pain (CLBP) is difficult, as its primary causes are multiple. Clinical, radiological and electrophysiological findings are of limited value in diagnosing radiculopathy as the cause of CLBP in early cases. Current study was undertaken on 50 controls and 50 CLBP patients without clinical neurological deficit to evaluate the potential of nerve conduction studies, particularly H-reflex study for diagnosis of radiculopathy in these cases. We observed that routine nerve conductions in CLBP without clinical neurodeficit showed no significant differences; whereas all the H-reflex parameters, H-threshold, H latency, H amplitude and H/M ratio were significantly different when compared with that of control (P value <0.0001 in each case). We concluded that subclinical cases might not have only partial conduction block but also secondary axonal loss due to compression of nerve roots. We further suggest inclusion of Soleus H-reflex study in evaluation of radiculopathy among early CLBP cases without clinical neurodeficit.

Correlation among routine semen parameters, sperm viabilty and malondialdehyde levels in human subjects with different fertility potential.

Percentage of viable sperms has good potential to reflect male fertilizing potential. In the present study, an attempt was made to find out the percentage of viable sperms in normal and abnormal ejaculates and influence of reactive oxygen species in affecting the viability of sperm. Malondialdehyde (MDA) in seminal plasma of normal and abnormal ejaculates was measured by Thiobarbituric Acid method and percentage of viable sperms was assessed by Eosin-Nigrosin staining. The results revealed that the abnormal semen samples have significantly lower number of viable spermatozoa (59.06±9.63% vs. 68.33±5.46%, P<0.05) and higher levels of MDA (2.53±0.66 vs. 1.66±0.37 nmol/ml, P<0.05) as compared to normal. A significant negative correlation was found between seminal MDA level and sperm viability. Based on the results obtained from the present study, we suggest that viability of sperm is an authentic parameter to assess male fertility potential and it can be affected significantly by oxidative stress.

Effects of calcium, strontium, and barium on isolated phrenic nerve-diaphragm preparation of rat and their interactions with diltiazem and nifedipine.

Calcium (Ca2+), strontium (Sr2+), and barium (Ba2+) are expected to exert similar chemical and pharmacological effects. The effects of barium, strontium and calcium were studied on the contractions of rat phrenic nerve-diaphragm preparations, following electrical stimulation and their interactions with nifedipine (nif) and diltiazem (DZM) were also studied. Low doses of strontium chloride (SrCl2), barium chloride (BaCl2) and calcium chloride (CaCl2) were able to increase the force of contraction of the rat diaphragm when actively stimulated. Diltiazem inhibited the stimulant effects of Sr2+, Ba2+, and Ca2+. On the other hand, nifedipine blocked the effects of Sr2+ and Ca2+ but potentiated the effects of Ba2+. Strontium, barium, and calcium restored the contractility of the muscle following electrical stimulation when the tissue was in biological fluid absolutely depleted of calcium. These findings suggest that Sr2+ and Ba2+ may be able to substitute Ca2+ in the rat diaphragm for its contractions and nifedipine and diltiazem may follow different mechanisms of actions or channels in their blocking effects.